[Federal Register Volume 62, Number 75 (Friday, April 18, 1997)] [Notices] [Pages 19154-19155] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 97-10085] ======================================================================= ----------------------------------------------------------------------- SOCIAL SECURITY ADMINISTRATION Agency Information Collection Activities: Proposed Collection Requests This notice lists information collection packages that will require submission to the Office of Management and Budget (OMB), in compliance with Public Law 104-13 effective October 1, 1995, The Paperwork Reduction Act of 1995. 1. Consent for Release of Information--0960-0567. The information collected on form SSA-3288 is used by the Social Security Administration (SSA) to ensure that an individual consents to the release of his/her personal information to another individual. The respondents are individuals assenting to the disclosure of information from their social security records to someone else. Number of Respondents: 200,000. Frequency of response: 1. Average Burden Per Response: 3 minutes. Estimated Annual Burden: 10,000 hours. 2. Application for Special Age 72-or-Over Monthly Payments--0960- 0096. The information collected on form SSA-19 is used by SSA to determine entitlement of individuals to special age 72-or-over payments. The respondents are applicants who file for the special payment. Number of Respondents: 15. Frequency of Response: 1. Average Burden Per Response: 20 minutes. Estimated Average Burden: 5 hours. 3. Request for Self-Employment Information (SSA-2765), Request for Employment Information (SSA-3365), Request for Employer Information (SSA-4002)--0960-0508. The information is needed by SSA when earnings information reported to the agency is incomplete or incorrect. The information is used to post the reported earnings to the appropriate earnings record. The respondents are employers of the wage earners or employees and self-employed individuals for whom the earnings were reported. Number of Respondents: 3,000,000. Frequency of Response: 1. Average Burden Per Response: 10 minutes. Estimated Annual Burden: 500,000 hours. 4. State Agency Report of Obligations for SSA Disability Program-- 0960-0421. The information collected on form SSA-4513 is used by SSA in a detailed analysis and evaluation of costs incurred by the State Disability Determination Services (DDS) in making determinations of disability for SSA and to determine funding levels for each DDS. The respondents are State DDS offices. Number of Respondents: 54. Frequency of Response: 4. Average Burden Per Response: 1 hour. Estimated Annual Burden: 216 hours. 5. State Vocational Rehabilitation Agency Claim (SSA-199) and Subpart V--Payments for Vocational Rehabilitation Services, 20 CFR Sections 404.2104, 404.2108, 404.2113, 404.2117, 404.2121, 416.2204, 416.2208, 416.2213 and 416.2217--0960-0310. The information collected on form SSA-199 and through this current rule is used by the Social Security Administration to determine if State vocational rehabilitation agencies are providing appropriate services, including referrals when necessary, and whether those claims for services should be paid. Number of Respondents: 80-100. Frequency of Response: On occasion. Average Burden Per Response: Varies from 23 minutes to 4 hours. Estimated Annual Burden: 8,465 hours. Written comments and recommendations regarding the information collection(s) should be sent within 60 days from the date of this publication, directly to the SSA Reports Clearance Officer at the following address: Social Security Administration, DCFAM, Attn: Judith T. Hasche, 6401 Security Blvd., 1-A-21 Operations Bldg., Baltimore, MD 21235. In addition to your comments on the accuracy of the agency's burden [[Page 19155]] estimate, we are soliciting comments on the need for the information; its practical utility; ways to enhance its quality, utility and clarity; and on ways to minimize burden on respondents, including the use of automated collection techniques or other forms of information technology. To receive a copy of any of the forms or clearance packages, call the SSA Reports Clearance Officer on (410) 965-4123 or write to her at the address listed above. Dated: April 11, 1997. Frederick W. Brickenkamp, Forms Management Officer, Social Security Administration. [FR Doc. 97-10085 Filed 4-17-97; 8:45 am] BILLING CODE 4190-29-P